Neurology & Pain Management Coding Alert
Use surgery diagnosis for intraoperative EMG
Question: My neurologist goes into the operating room to monitor a patient's nerves during surgery. But the diagnosis for the electromyogram (EMG) winds up being different from the intraoperative monitoring (IOM) code. Which diagnosis should I use? New Jersey Subscriber Answer: If the neurologist performs electrodiagnostic testing such as EMG, evoked potentials or nerve conduction studies (using, for instance, 95860-95864; 95925-95937; 95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study; or 95904, ... sensory), you should report the same diagnosis you used to create the medical necessity for the IOM. This is typically the diagnosis you use to establish the need for the surgery. Example: The patient undergoes lumbar spinal fusion at multiple levels due to lumbar spinal stenosis. The surgeon and anesthesiologist will probably use 721.4x (Lumbar spondylosis with myelopathy). Therefore, the neurologist performing the baseline electrodiagnostic testing with IOM should also use 721.4x to create medical necessity for the CPT codes he submits (including the baseline study and the IOM, +95920, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]).
Neurology & Pain Management Coding Alert
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